JP7240705B2 - Surgical soft surgical instrument exchange device and its surgical soft surgical instrument - Google Patents

Description

TECHNICAL FIELD The present invention relates to a soft surgical instrument changing device and a soft surgical instrument, and more specifically, a soft surgical instrument changing device and a soft surgical instrument suitable for surgery using an endoscope. Regarding.

In recent years, with the miniaturization of endoscopes or laparoscopes, minimally invasive endoscopic surgery or laparoscopic surgery, which is laparoscopic surgery, has been widely used. As such a surgical instrument, there is known a master-slave operation system that includes a master manipulator operated by an operator and a slave manipulator that operates based on signals emitted from the master manipulator. A surgical instrument having a treatment portion for treating a treatment target site is attached (see Patent Document 1).

Although endoscopic surgery has the great advantage of being minimally invasive for patients, there are limitations on the shape and operability of surgical instruments. Various techniques have been disclosed. For example, in order to facilitate maintenance such as cleaning and sterilization, techniques related to surgical instrument exchange are disclosed in which surgical instruments are detachable with a simple configuration (see Patent Documents 1 and 2). Furthermore, when the affected part exists deep inside the body, a technique is disclosed regarding a soft surgical tool that applies a flexible conductor or a mechanism that bends from a conventional linear shape in order to bypass organs when the surgical tool reaches the relevant site. (See Patent Documents 3 and 4).

Further, in a treatment instrument storage device for accommodating an endoscopic procedure having an elongated flexible sheath, a case body, a treatment instrument insertion port opened on one side surface of the case body, and a An operating portion housing portion communicating with the mouth, a sheath housing portion formed in a loop shape communicating with the operating portion housing portion, and treatment instrument fixing means for detachably fixing the treatment instrument in the stored state. A technique is disclosed in which the case body is formed in the shape of a flat plate and the sheath housing portion is formed of a tube (see Patent Document 5).

Japanese Patent No. 6010027 Japanese Patent No. 6202430 JP 2015-80556 A Japanese Patent Application Laid-Open No. 2018-68708 JP-A-57-164051

In the techniques described in Patent Literatures 1 and 2, the surgical instrument can be replaced easily by providing a removable surgical instrument portion. I had to. The technique described in Patent Document 3 requires a large number of parts and a large number of moving parts because a complicated opening and closing mechanism is provided to realize tilting and rolling of the surgical instrument. Therefore, it has been difficult to improve the productivity of the sterilization work and subsequent assembly work.

In the technique described in Patent Document 4, the forceps can be opened and closed with a simple configuration, but there is a problem that it takes time to replace the surgical instrument. The technique described in Patent Document 5 is for simply storing and removing forceps having an elongated sheath, and when exchanging surgical tools during surgery, the operator takes out (pulls out) the forceps from within the living body. I needed it.

SUMMARY OF THE INVENTION The present invention has been made in view of these circumstances in the above background, and is a flexible surgical instrument exchange device that facilitates the exchange of surgical instruments and facilitates management of the sanitary conditions of the replaced surgical instruments. It is an object of the present invention to provide a soft surgical instrument suitable for a soft surgical instrument exchange device and its soft surgical instrument exchange device.

INDUSTRIAL APPLICABILITY The present invention is an exchange device for a soft surgical instrument used in endoscopic surgery. A soft surgical instrument exchange device, which is one aspect of the present invention, includes a soft surgical instrument that can be inserted into and removed from a living body and bendable in the living body; a storage unit in which a plurality of the housings arranged in a multistage stack in the vertical direction are stored; a replacement unit having an elevating mechanism that lowers or raises the unit; and a delivery unit that moves, in the direction of the living body, one of the plurality of cases whose position in the vertical direction matches the position of the transport surface. and a surgical instrument operating section in which the moved housing is accommodated. Further, the housing is configured to be exchanged according to the application.

According to the above configuration, a plurality of housings each storing a soft surgical instrument according to the application is provided, and the surgical instrument can be easily exchanged by exchanging the housings according to the application. In addition, by providing a surgical tool suitable for each surgical operation in each housing, it is possible to easily manage the sanitary condition of the replaced surgical tool. That is, storage and management are facilitated by storing the soft surgical tool in a case in a so-called cassette format with built-in functional parts/devices. By unifying the size and shape, it is possible to standardize the device for exchanging soft surgical instruments. Furthermore, by providing the replacement unit and the delivery unit, it becomes easy to prevent medical malpractice due to human error in selecting the soft surgical tool.

In the above aspect, the soft surgical instrument includes a flexible cord-shaped insertion section having a distal end attached with a treatment instrument that opens and closes, and an operation section that operates the opening and closing movement of the treatment instrument, wherein the insertion section is , a storage drum including a wire having one end connected to the treatment instrument, and an outer tube covering the wire, wherein the operation section winds and rotates the insertion section to insert and extract the insertion section. and an opening/closing mechanism to which the other end of the wire is fixed, which rotates in cooperation with the storage drum and is movable in a direction different from the winding direction, wherein the opening/closing mechanism is in a direction different from the winding direction. An operation in which the treatment instrument is opened and closed by moving the housing drum in the axial direction, and the housing drum rotates the housing drum and the movement of the housing drum in the axial direction is operated from outside the housing. The soft surgical instrument changer can be configured such that a connection is provided.

The above configuration is a technique of the inventor described in Patent Literature 4, and is a master that can independently perform two different operations, that is, the opening/closing operation of the opening/closing device and the sending/retracting of the opening/closing device itself.・It is applied to a soft surgical instrument exchange device as a cassette in which a slave type operation system is built in a housing.

Specifically, the rotation of the storage drum advances and retracts the external insertion tube to insert and withdraw the soft surgical instrument into and out of the living body. By moving a part of the storage drum, for example, in an axial direction, which is different from the winding direction of the external tube of the storage drum, the wire attached to this part can be fed and pulled in by the external tube. It is performed independently of movement. By connecting the opening/closing device to the wire, the sending/retracting of the wire can be converted into the opening/closing operation.

Therefore, according to this configuration, it is possible to easily operate (open/close, send out, retract, etc.) the surgical tool even if it is a cassette in which a soft surgical tool suitable for the application is stored. In addition, since a complicated mechanism is not included in the surgical instrument portion on the distal end side to be inserted into and removed from the living body, hygiene management such as cleaning and sterilization is facilitated. Furthermore, since there is no rotation, power transmission mechanism, connection mechanism, etc., and the number of parts is reduced compared to the conventional technology, it is advantageous in terms of cost and productivity.

In the above aspect, the surgical instrument operation section is provided with an operation mechanism connected to the operation connection section, and rotation of the operation mechanism rotates the storage drum via the operation connection section. Pushing and pulling of the operating mechanism may move the opening and closing mechanism in the axial direction.

According to the above configuration, the opening/closing mechanism of the slave side can be easily operated by the master side by providing the operation mechanism in the surgical instrument operation section without requiring a complicated mechanism. By exposing the side surface of the housing drum of the cassette, holes and hook-like projections are provided on this surface so that the holes and projections can be operated from the outside. In this way, the opening/closing operation of the opening/closing mechanism and the sending/retracting of the opening/closing mechanism itself can be operated on the master side. Then, it is possible to operate the opening/closing mechanism according to the operator's intention.

In the soft surgical instrument provided in the soft surgical instrument exchange device according to the aspect described above, the outer tube houses a plurality of the wires having one end connected to the treatment instrument, and the other end of each of the wires is connected to the treatment instrument. However, the soft surgical instrument can be configured to move independently in the axial direction of the storage drum.

The above configuration is provided with a plurality of independent mechanisms for retracting the wires by moving the storage drum in the axial direction. By realizing the state and then pulling in the other wire, the one wire is returned to its original state and allowed to return to the closed state. In Patent Document 4, the operation is limited to one direction of opening or closing. For example, after opening the opening/closing mechanism by pulling in the wire, another mechanism is required to return it to the closed state. However, according to this configuration, by independently retracting a plurality of wires, the opening operation and the closing operation can be performed independently, and the gripping force of the wire opening/closing device can be adjusted by adjusting the retracting force. It is suitable for gripping organs and affected parts in different states.

In the soft surgical instrument provided in the soft surgical instrument exchange device of the aspect described above, the treatment instrument has a common rotation shaft, and is rotated in different directions to perform the opening and closing movement. The first rotating portion and the second rotating portion each have an arcuate shape having a first center eccentric to the opening operation side of the rotating surface with respect to the rotating shaft. A first groove and an arc-shaped second groove having a second center that is eccentric on the closing operation side of the rotation surface are formed. One wire is connected to the first groove of the rotating portion, and a first pin that is movable on the rotating surface is inserted. The flexible surgical tool can be configured such that the other wire is connected to the second groove of the rotating portion, and the second pin that is movable on the rotating surface is inserted.

According to the above configuration, when the wire connected to the first pin is drawn when the opening/closing mechanism is in the closed state, the first pin is drawn. Since the first rotating portion and the second rotating portion have a common center of rotation, the first pin is separated from the center of rotation by the first groove of the first rotating portion and the second rotating portion. slides in the first groove of to rotate the first rotating portion and the second rotating portion. When the first pin reaches the end of the first groove, the first rotating portion and the second rotating portion stop rotating, and the opening/closing mechanism is opened.

When the wire connected to the second pin is then retracted, the second pin is pulled. Since the first rotating portion and the second rotating portion have a common center of rotation, the second pin is positioned away from the center of rotation by the second groove of the first rotating portion and the second rotating portion. slides in the second groove to rotate the first rotating portion and the second rotating portion. When the second pin reaches the end of the second groove, the rotation of the first rotating portion and the second rotating portion stops, and the opening/closing mechanism is closed.

According to this configuration, by independently retracting a plurality of wires, the opening operation and the closing operation can be performed independently, and the gripping force of the wire opening/closing device can be adjusted by adjusting the retracting force.

In the soft surgery instrument provided in the soft surgery exchange device of the above aspect, the insertion portion is rotatably inserted into a cylindrical exterior portion and the exterior portion so as to restrict rotation of the treatment instrument. and a driving bevel gear that rotates around a rotation axis in a direction perpendicular to the insertion/extraction direction into the living body by moving the wire in the axial direction of the housing drum. and a driven bevel gear provided on the rotating portion and meshing with the driving bevel gear.

According to the above configuration, by rotating the driving bevel gear by pushing and pulling the wire, the driven bevel gear meshing with the driving bevel gear can be rotated to rotate the treatment instrument. Such a configuration can rotate the opening/closing device to a proper position for gripping the affected part.

In the soft surgical instrument provided in the soft surgical instrument exchange device of the above aspect, the outer tube accommodates a flexible shaft having one end connected to the treatment instrument, and the other end of the flexible shaft is rotated. , the soft surgical instrument can be configured to rotate the treatment instrument.

A flexible shaft is an elongated flexible shaft component that can transmit rotational power to a remote location. According to the above configuration, the surgical instrument can be rotated by arranging the flexible shaft coaxially with the wire and rotating the flexible shaft. As for the flexible shaft, it is preferable to extend it as close to the axis as possible so that resistance (friction, wear) when the surgical instrument is rotated by the rotation of the shaft is reduced.

Note that the bevel gear rotates the surgical instrument by pushing and pulling the wire, and the flexible shaft directly rotates the surgical instrument, but these configurations can be appropriately selected depending on the storage space and bending conditions.

The present invention provides a flexible surgical instrument exchange device that facilitates exchange of surgical instruments and easily manages the sanitary conditions of the exchanged surgical instruments, and a flexible surgical instrument suitable for the flexible surgical instrument exchange device. can do.

1 is an explanatory diagram of a soft surgical instrument exchange device according to a first embodiment of the present invention; FIG. FIG. 4 is a perspective view of a storage section of the flexible surgical instrument changing device according to the first embodiment of the present invention; FIG. 2 is a perspective view of a soft surgical instrument unit applied to the soft surgical instrument exchange device according to the first embodiment of the present invention; FIG. 4 is an explanatory view showing a cross section of a soft surgical instrument unit applied to the soft surgical instrument exchange device according to the first embodiment of the present invention; FIG. 4 is a perspective view of a first scanning connection portion of the surgical instrument operating section of the flexible surgical instrument changing apparatus according to the first embodiment of the present invention; FIG. 4 is a perspective view of a second scanning connection portion of the surgical instrument operating section of the flexible surgical instrument changing apparatus according to the first embodiment of the present invention; FIG. 4 is a perspective view showing a state in which the first scanning connection portion of the surgical instrument operating section of the flexible surgical instrument changing apparatus according to the first embodiment of the present invention is connected to the flexible surgical instrument unit; FIG. 4 is a perspective view from the back side of FIG. 3 of the soft surgical instrument unit applied to the soft surgical instrument exchange device according to the first embodiment of the present invention; FIG. 4 is a cross-sectional view showing a state in which the first scanning connection section of the surgical instrument operating section of the flexible surgical instrument changing apparatus according to the first embodiment of the present invention is connected to the flexible surgical instrument unit; FIG. 4 is a cross-sectional view showing the structure of a storage drum of the flexible surgical instrument changing device according to the first embodiment of the present invention; FIG. 4 is a perspective view showing a state where the delivery section of the soft surgical instrument exchange device according to the first embodiment of the present invention is connected to the soft surgical instrument unit; FIG. 10 is an explanatory view showing the operation of an example of the opening/closing device of the flexible surgical instrument changing device according to the second embodiment of the present invention; FIG. 7 is a cross-sectional view showing the opening/closing device of the flexible surgical instrument changing device according to the second embodiment of the present invention; FIG. 8 is a perspective view of an opening/closing guide of the opening/closing device of the flexible surgical instrument changing device according to the second embodiment of the present invention; FIG. 11 is a perspective view showing an operating portion of a soft surgical instrument changing device according to a second embodiment of the present invention; FIG. 10 is an explanatory view showing the opening and closing operation of the soft surgical instrument exchange device according to the second embodiment of the present invention; FIG. 11 is an explanatory view showing the operation of another example of the opening/closing device of the flexible surgical instrument changing device according to the second embodiment of the present invention; FIG. 11 is a perspective view of a rotating part of an opening/closing device of a flexible surgical instrument changing device according to a third embodiment of the present invention; FIG. 11 is a perspective cross-sectional view showing the internal structure of the rotating part of the opening/closing device of the flexible surgical instrument changing device according to the third embodiment of the present invention; FIG. 11 is an explanatory diagram showing the operation of the rotating part of the opening/closing device of the flexible surgical instrument changing device according to the fourth embodiment of the present invention; FIG. 11 is a perspective view of a rotating portion of an opening/closing device of a flexible surgical instrument changing device according to a fifth embodiment of the present invention;

BEST MODE FOR CARRYING OUT THE INVENTION A flexible surgical instrument exchanging device of the present invention and a preferred embodiment of the soft surgical instrument exchanging device will be described below with reference to the drawings. In the following description, it may be assumed that configurations denoted by the same reference numerals in different drawings are the same, and description thereof may be omitted.

According to one aspect of the present invention, a soft surgical instrument that can be inserted into and pulled out of a living body and bendable in the living body, a housing that stores a plurality of the soft surgical instruments according to the application, and a plurality of vertical stages. A storage unit in which a plurality of the housings arranged in a stack are stored, and the storage unit is lowered or raised so that the positions of the plurality of housings in the vertical direction sequentially coincide with the positions of the conveying surface. a replacement unit having an elevating mechanism; a delivery unit for moving, in the direction of the living body, one of the plurality of housings whose vertical position coincides with the position of the transport surface; and the moved housing. A surgical instrument operation unit in which a body is housed, and the housing is exchangeable according to the application. I do not care.

(First embodiment)
First, a soft surgical instrument exchange device according to a first embodiment of the present invention will be described with reference to FIGS. 1 to 11. FIG. FIG. 1 is an explanatory diagram of a soft surgical instrument exchange device according to a first embodiment of the present invention. FIG. 2 is a perspective view showing the storage portion of FIG. 1. FIG. FIG. 3 is a perspective view of a soft surgical instrument unit applied to a soft surgical instrument exchange device. FIG. 4 is an explanatory diagram showing a cross section of the soft surgical instrument unit. FIG. 5 is a perspective view of the first scanning connection section of the surgical instrument operation section. FIG. 6 is a perspective view of the second scanning connection portion of the surgical instrument operation section. FIG. 7 is a perspective view showing a state in which the first scanning connection section is connected to the soft surgical instrument unit. FIG. 8 is a perspective view from the back side of FIG. 3 of the soft surgical instrument unit applied to the soft surgical instrument exchange device according to the present embodiment. FIG. 9 is a cross-sectional view showing a state in which the first scanning connection section of the surgical instrument operating section of the flexible surgical instrument changing apparatus according to the present embodiment is connected to the flexible surgical instrument unit. FIG. 10 is a cross-sectional view showing the structure of the storage drum. FIG. 11 is a perspective view showing a state where the delivery section of the soft surgical tool exchange device is connected to the soft surgical tool unit.

<Overall description of the soft surgical instrument exchange device>
Referring to FIG. 1(A), the soft surgical instrument exchange device 1 is installed so that the living body is positioned on the left side of the drawing. In FIG. 1, the vertical direction in the drawing is the vertical direction when the flexible surgical instrument exchange device 1 is arranged, and it may be simply referred to as the vertical direction in the following description. It is also assumed that the living body to be treated is positioned in the left direction of FIG. 1(A).

The soft surgery exchange device 1 includes a surgical tool unit 100 that stores soft surgical tools that can be inserted into and removed from the living body and that can be bent in the living body, and is made up of a plurality of housings that respectively store a plurality of soft surgical tools according to the application. Then, the storage section 20 in which a plurality of surgical tool units 100 arranged in multiple layers in the vertical direction are stored, and the position of each of the surgical tool units 100 in the vertical direction sequentially coincides with the position of the transport surface 45. and a surgical tool unit 100 whose vertical position among the plurality of surgical tool units 100 coincides with the position of the transport surface 45. It has a delivery section 40 that moves toward the living body, and a surgical instrument operation section 50 that houses the surgical instrument unit 100 that has been moved. Hereinafter, individual configurations included in the present embodiment will be described, and then the replacement operation in the soft surgical instrument replacement device 1 will be described.

<Description of the storage part>
Referring to FIG. 2, the storage unit 20 includes a storage box 21 having a plurality of mounting shelves 22 formed therein. The storage box 21 is, for example, a hollow hexahedron, and has a box-like shape with an opening 25 on one side facing the operating unit 50 . It is

The belt 35 is engaged by two rollers 34 at upper and lower sides, and by rotating either one or both of the rollers 34, the belt 35 is rotated, and the storage box 21 attached to the belt 35 is moved. Up and down.

The mounting shelf 22 can be formed as a convex step facing the same height in the left-right direction of the opening 25 having a surface for mounting the surgical tool unit 100 thereon. Note that the mounting shelf 22 may be configured as a convex step on which the surgical tool unit 100 is placed as shown in the figure, or may be shaped like a box capable of storing the surgical tool unit 100 . Moreover, the number of stages of the placing shelf 22 is at least two, and the number of stages is provided according to the operation.

<Description of surgical tool unit 100>
Referring to FIGS. 3 and 4, the surgical instrument unit 100 is a housing for storing a soft surgical instrument, and the soft surgical instrument is a flexible cord-like device having an opening/closing device 200 attached to its distal end, which is a treatment instrument that opens and closes. It has a flexible operation member 122 serving as an insertion portion, an operation portion 116 for operating the opening/closing motion of the opening/closing device 200, and a storage drum 110 around which the flexible operation member 122 is wound.

The storage drum 110 is housed in the surgical tool unit 100 so as to be rotatable in the winding direction of the flexible operation member 122 . The operation portion 116 is accommodated in an operation portion accommodation portion 111 which is a bottomed hole formed in the storage drum 110 so as to be movable in the rotational axis direction of the storage drum 100 . The operation part 116 is engaged with the storage drum 110 by a detent key 118 fitted in a key groove 119 so as to rotate in cooperation with the storage drum 110 and move in the rotational axis direction. Furthermore, in order to regulate the movement of the operation portion 116 in the rotation axis direction of the storage drum 110 and to stabilize the attitude and position, the operation portion accommodating portion 111 is biased by a biasing device 114 such as a spring from the bottom.

The flexible operation material 122 is composed of an operating wire 124 having one end connected to the opening/closing device 200 and an outer tube 126 covering the operating wire 124, and is wound around the flexible operation material storage groove 113 formed in the storage drum 110. . By rotating the storage drum 110, the flexible operation member 122 is sent out and retracted, and the opening/closing device 200 can be inserted into and pulled out of the living body. Also, the other end of the operating wire 124 is connected to the operating portion 116 .

Referring also to FIGS. 5 and 7, a first operation connecting portion 141 having a rod 142 having a cylindrical tip portion with a small diameter is arranged so that the tip of the rod 142 is in contact with the operation portion 116. there is

6 and 8 also show a state in which the surgical tool unit 100 and the lower surface of the storage drum 110 are flush with each other. A plurality of bottomed engagement holes 117 are formed in the lower surface of the storage drum 110 , and are arranged to engage with the engagement pins 144 formed in the second operation connecting portion 143 . An operating connection 143 is provided. The engagement hole 117 may have a hole shape such as a square hole or a spur gear, and the engagement pin 144 of the second operation connecting portion 143 serving as a counterpart may be a square hole or a spur gear. In such a configuration, the number of engagement holes 117 may be one instead of plural.

A mounting protrusion 160 for mounting the surgical tool unit 100 on the mounting shelf 22 is formed on a side surface parallel to the direction in which the opening/closing device 200 of the surgical tool unit 100 expands and contracts due to the winding of the flexible operation member 122 . 2, the mounting projection 160 is mounted on the mounting shelf 22 so that the surgical instrument unit 100 is stored in the storage box 21. As shown in FIG.

Next, referring also to FIGS. 9 and 10, the feeding operation and the opening/closing operation of the opening/closing device 200, which is the opening/closing mechanism of the present embodiment, will be described. As shown in FIG. 10(A), a flexible operation member 122 including an operating wire 124 and an outer tube 126 that serves as its outer covering is wound around a flexible operation member storage groove 113 of a storage drum 110 . The operating portion 116 to which the other end of the operating wire 124 is connected is engaged with the storage drum 110 by a detent key 118 so as to rotate in cooperation with the storage drum 110 .

Next, referring to FIG. 10B, since the operation part 116 rotates in cooperation with the storage drum 110, the operating wire 124 and the flexible operation member 122 can operate the opening/closing device 200 while maintaining their positional relationship. send out. In this manner, the opening/closing device 200 can be freely inserted into and removed from the living body while maintaining the state of the opening/closing device 200 . The storage drum 110 may be rotated manually by providing a handle or the like, or may be rotated by being connected to a motor.

FIG. 9 illustrates the opening/closing operation of the opening/closing device 200, and the exterior tube 126 that serves as the outer covering of the operating wire 124 is not shown. Referring to FIG. 9A, the operation unit 116 is not urged by the first operation connection unit 141, and the urging device 114 regulates the vertical movement and stabilizes the attitude and position of the operation unit 116. It is accommodated above the part accommodating portion 111 .

One end of the operating wire 124 is connected to the opening/closing device 200 , and the other end is connected to a wire locking portion 125 provided on the cylindrical side surface of the operating portion 116 . The relative positions of the actuating wire 124 and the armor tube 126 do not change even if the armor tube 126 (not shown in FIG. 9) is advanced leftward or retracted rightward. Therefore, the opening/closing device 200 maintains the closed state as shown in FIG. 9(A). In FIGS. 10A and 10B, even if the flexible operation member 122 is delivered, the relative positions of the operating wire 124 and the flexible operation member 122 do not change, and the opening/closing device 200 maintains its open state. is shown.

Referring to FIG. 9B, the first operation connection portion 141 moves downward, and the operation portion 116 is also moved downward by being pushed by the first operation connection portion 141 . Since the operation portion 116 is urged upward by the urging device 114 , the amount of downward movement of the first operation connecting portion 141 is the amount of downward movement of the operation portion 116 .

When the operating portion 116 moves downward, the actuating wire 124 connected to the wire locking portion 125 is drawn rightward in the arrow T direction relative to the flexible operating member 122 (not shown). The opening/closing device 200 can be opened by using this retraction operation. For example, in the case of scissors-like forceps having two hinged blades, the opening and closing mechanism can be opened by attaching an operating wire 124 to one blade and moving only the blade to the right. However, there is no particular limitation.

Referring to FIGS. 8 and 11, a notch 150 is formed in the surgical tool unit 100 from the upper surface to the lower surface in the thickness direction. The shape of the notch 150 matches the outer shape of the engagement portion 42 formed at the end of the delivery rod 41 provided in the delivery portion 40 , and the operation tool unit 100 is moved up and down by the elevation transfer portion 33 so that the engaging portion 150 can be engaged. The joint 42 is accommodated within the notch 150 .

<Explanation of exchanging soft instruments>
Referring again to FIG. 1, the soft surgical exchange will be described. FIG. 1(A) shows a state in which a plurality of surgical instrument units 100, which are stacked in multiple stages in the vertical direction, are housed in the housing portion 20 of the soft surgery exchange device 1. FIG. In the surgical instrument operation unit 50, a surgical instrument positioning tool 51 having a predetermined space in the vertical direction is provided on the left side of the living body. The surgical tool positioning tool 51 is, for example, a rod-shaped member extending in the depth direction of the drawing, and a roller or the like can be applied. The predetermined interval is set so as to regulate the vertical movement of the surgical tool unit 100 according to the dimension of the surgical tool unit 100 in the thickness direction. The transport surface 45 represents a horizontal movement surface of the surgical tool unit 100 .

When the surgical tool unit 100 to be used is selected, a command is sent to the exchange section 30 and the delivery section 40 . The exchange section 30 drives the rollers 34 of the elevation transfer section 33 to move the selected surgical tool unit 100 to the position of the transfer surface 45 . At this time, the engaging portion 42 of the delivery rod 41 of the delivery portion 40 is positioned on the conveying surface 45 so as to be engaged with the notch 150 of the surgical tool unit 100, and is engaged by the movement of the surgical tool unit 100. Portion 42 and notch 150 engage.

Referring to FIG. 1B, the delivery rod 41 pushes the surgical tool unit 100 engaged with the notch 150 leftward along the transport surface 45 . At this time, the surgical instrument unit 100 is arranged so as to be sandwiched between the surgical instrument positioning tools 51, and the engagement pin 144 of the second operation connecting portion 143 and the engagement hole 117 engage with each other. The instrument unit 100 is stably arranged in the surgical instrument operating section 50 . Then, the first operation connection portion 141 descends and the rod 142 connects to the operation portion 116 . Here, the replacement work can be made smoother by transporting the surgical tool unit 100 to the left by using the positioning tool 51 as a roller that rotates using the power of a motor or the like.

When the surgical tool unit 100 is replaced, the opening/closing device 200 can be operated by the first operation connection section 141 and the flexible operation material 122 can be delivered and retracted by the second operation connection section 143 .

(Second embodiment)
Next, a second embodiment of the invention will be described. The second embodiment of the present invention is an embodiment relating to the mechanism of the opening/closing device, and other configurations are the same as those of the first embodiment. The explanation is omitted. In the following, the opening/closing device according to this embodiment will be described, and then the mechanism for operating this opening/closing device will be described. FIG. 12 is an explanatory view showing the operation of one example of the opening/closing device of the flexible surgical instrument exchange device according to the second embodiment of the present invention. FIG. 13 is a cross-sectional view showing the opening/closing device of the flexible surgical instrument exchange device according to the second embodiment of the present invention. FIG. 14 is a perspective view of the opening/closing guide of the opening/closing device of the flexible surgical instrument exchange device according to the second embodiment of the present invention. FIG. 15 is a perspective view showing the operation section of the soft surgical instrument exchange device according to the second embodiment of the present invention. FIG. 16 is an explanatory diagram showing the opening and closing operation of the soft surgical instrument exchange device according to the second embodiment of the present invention. FIG. 17 is an explanatory view showing the operation of another example of the opening/closing device of the flexible surgical instrument exchange device according to the second embodiment of the present invention.

<Description of switchgear>
Referring to FIG. 12, the opening/closing device 201 according to the present embodiment has a common rotation center 230, and rotates in different directions to open and close a first rotating portion 210 and a second rotating portion 220. It consists of In FIG. 12, the first rotating portion 210 and the second rotating portion 220 have a line-symmetrical shape with respect to the center line passing through the rotation center 230 when the opening/closing device 201 is closed. However, it is sufficient that the grooves and the pins have the relationship described below.

The first rotating portion 210 has an arc-shaped first groove 242 having a first center 241 eccentric to the opening operation side of the rotation surface with respect to the rotation center 230, and a first groove 242 on the closing operation side of the rotation surface. An arc-shaped second groove 252 having an eccentric second center 251 is formed. The second rotating portion 220 also has an arc-shaped first groove 243 having a center that is symmetrical to the first center 241 eccentric to the opening operation side of the rotating surface with respect to the rotation center 230 , and A second eccentric center 251 and an arcuate second groove 253 having a center at a line symmetrical position are formed on the closing operation side of the moving surface. Note that the eccentric center of each of the second rotating parts 220 is omitted to avoid complicating the drawing.

A first pin 240 is inserted through the first groove 242 of the first rotating portion 210 and the first groove 243 of the second rotating portion 220 so as to be movable on the rotating surface. Referring also to FIG. 13, a first wire 271 is connected to the first pin 240 as an actuation wire. Similarly, the second pin 250 is inserted through the second groove 252 of the first rotating portion 210 and the second groove 253 of the second rotating portion 220 so as to be movable on the rotating surface. A second wire 272 is connected to the second pin 250 as an actuation wire.

Referring to FIGS. 13 and 14, the opening/closing device 201 including the first rotating portion 210 and the second rotating portion 220 is accommodated in an opening/closing guide 260 having a U-shaped cross section. The open/close guide 260 is formed with a rotation shaft 231 that serves as a rotation axis of the rotation centers 230 of the first rotation portion 210 and the second rotation portion 220 . In the flat plate forming the upper and lower surfaces of the opening/closing guide 260, oval guide grooves 261 and 262 are formed through the upper and lower surfaces. The first pin 240 and the second pin 250 are inserted through the guide grooves 261 and 262 and are movable in the longitudinal direction of the ellipse.

As described above, the first pin 240 is connected with the first wire 271 as the operating wire, and the second pin 250 is connected with the second wire 272 as the operating wire. You can pull the wire.

Referring to FIGS. 12A and 12B together, FIG. 12A shows a state in which tension is not applied to the first wire 271 and the second wire 272, which are the operating wires, and the opening/closing device 201 is closed. It is in a state of The distance between the first pin 240 and the second pin 250 at this time is LP.

When the first wire 271 connected to the first pin 240 is pulled in when the opening/closing mechanism 201 is in the closed state, the first pin 240 is pulled rightward in the figure. Since the first rotating portion 210 and the second rotating portion 220 have a common center of rotation 230 , the first pin 240 is positioned away from the center of rotation 230 in the first groove of the first rotating portion 210 . 242 and the first groove 243 of the second rotating portion 220 to rotate the first rotating portion 210 and the second rotating portion 220 . When the first pin 240 reaches the ends of the first grooves 242 and 243, the rotations of the first rotating portion 210 and the second rotating portion 220 stop, and the opening/closing mechanism 201 enters the open state shown in (B). As shown in FIG. 12(B), in the open state, the distance LP between the first pin 240 and the second pin 250 is shorter than in (A).

Next, when the second wire 272 connected to the second pin 250 is pulled in, the second pin 250 is pulled rightward in the figure. Since the first rotating portion 210 and the second rotating portion 220 have a common center of rotation 230 , the second pin 250 is positioned away from the center of rotation 230 in the second groove of the first rotating portion 210 . 252 and the second groove 253 of the second rotating portion 220 to rotate the first rotating portion 210 and the second rotating portion 220 . When the second pin 250 reaches the ends of the second grooves 252 and 253, the first rotating portion 210 and the second rotating portion 220 stop rotating, and the opening/closing mechanism 201 enters the closed state shown in (A).

<Description of the mechanism for operating the switchgear>
FIG. 16 illustrates the opening/closing operation of the opening/closing device 201, and the exterior tube 126 that serves as the outer covering of the first wire 271 and the second wire 272 is not shown. Referring to FIG. 16C, the operation unit 216 is not urged by the first operation connection unit 141, and the urging device 114 regulates the vertical movement and stabilizes the attitude and position of the operation unit 216. It is accommodated above the part accommodating portion 281 . In FIG. 16B, the first operation connecting portion 141 is biased to the maximum, and in FIG. Thus, the biasing forces (A), (B), and (C) can be regulated as the amount of downward movement. That is, the amount of movement of the urging device 114 and the rod 142 becomes the amount of movement of the operating portion 216, and the tension of the actuating wire can be controlled by this amount of movement.

Referring also to FIG. 15, the operating portion 216 according to the present embodiment has a cylinder that is divided in half in the axial direction, slits 218 are provided between the half portions, and the vertical cross section of these half portions is long. The wire guide portion 217 formed in a cylindrical shape is used to connect the wires.

One ends of the first wire 271 and the second wire 272 are connected to the tensioner 219 by passing through the guide hole 221 that communicates from the side surface of the operation portion housing portion 281 of the housing drum 280 to the upper surface thereof. The first wire 271 led out to the guide hole 221 passes below the wire guide portion 217 in the slit 218, and the second wire 272 passes above the wire guide portion 217 in the slit 218, respectively. 13 are engaged with a first pin 240 and a second pin 250 .

A tensioner 219 is provided to constantly apply tension to the first wire 271 and the second wire 272 to eliminate slack. This is because if there is looseness, the opening/closing operation of the opening/closing device 201 cannot be controlled, and an unintended opening/closing operation may occur.

Referring to FIGS. 16A, 16B, and 16C, in (A) the first wire 271 and the second wire 272 are subjected to the same degree of tension, and in (B) the first wire 271 is applied to the second wire. A greater tension is applied than 272 , and in (C) the second wire 272 is subjected to a greater tension than the first wire 271 . 16A, 16B, and 16C, since the wire is connected to the tensioner 219, the wire with low tension does not loosen.

Specifically, when the states of FIGS. 16A, 16B, and 16C are applied to the operating state of the switching device 201, (B) is the open state and (C) is the closed state. Thus, in this embodiment, the opening/closing operation of the opening/closing device 201 can be reliably performed.

FIG. 17 shows an opening/closing device 300 as a modified example. Referring to FIG. 17, the opening/closing device 300 includes a first rotating portion 310 and a second rotating portion 320 that have a common center of rotation 330 and rotate in different directions to open and close. there is

The first rotating portion 310 includes an arc-shaped first groove 342 having a center (not shown) eccentric to the opening side of the rotating surface with respect to the rotation center 330 and a closing side of the rotating surface. A second arcuate groove 352 having a center (not shown) eccentric to the center is formed. The second rotating portion 320 also has an arc-shaped first groove 343 having a center (not shown) that is symmetrical with the center eccentric to the opening operation side of the rotating surface with respect to the rotation center 330, An arcuate second groove 353 having an eccentric center (not shown) and a line-symmetrical center is formed on the closing operation side of the rotation surface.

A first pin 340 is inserted through the first groove 342 of the first rotating portion 310 and the first groove 343 of the second rotating portion 320 so as to be movable on the rotating surface. An actuation wire (not shown) is connected to the first pin 340 . Similarly, a second pin 350 is inserted through the second groove 352 of the first rotating portion 310 and the second groove 353 of the second rotating portion 320 so as to be movable on the rotating surface. One actuation wire and another actuation wire (not shown) are connected to the second pin 350 .

Referring to FIGS. 17(A) and (B), (A) shows a state in which one actuation wire and the other actuation wire are not under tension, and the opening/closing device 300 is in a closed state. .

When one actuation wire connected to the first pin 340 is pulled in when the opening/closing mechanism 300 is in the closed state, the first pin 340 is pulled rightward in the figure. Since the first rotating portion 310 and the second rotating portion 320 have a common center of rotation 330 , the first pin 340 is positioned away from the center of rotation 330 in the first groove of the first rotating portion 310 . 342 and the first groove 343 of the second rotating portion 320 to rotate the first rotating portion 310 and the second rotating portion 320 . When the first pin 340 reaches the ends of the first grooves 342 and 343, the rotation of the first rotating portion 310 and the second rotating portion 320 stops, and the opening/closing mechanism 300 enters the open state shown in (B).

Next, when another actuation wire connected to the second pin 350 is retracted, the second pin 350 is pulled rightward in the figure. Since the first rotating portion 310 and the second rotating portion 320 have a common center of rotation 330 , the second pin 350 is positioned away from the center of rotation 330 by the second groove of the first rotating portion 310 . 352 and the second groove 353 of the second rotating portion 320 to rotate the first rotating portion 310 and the second rotating portion 320 . When the second pin 350 reaches the ends of the second grooves 352 and 353, the first rotating portion 310 and the second rotating portion 320 stop rotating, and the opening/closing mechanism 300 enters the closed state shown in (A).

Thus, even with the opening/closing mechanism 300 of the modified example, it is possible to realize the same operation as the opening/closing mechanism 201 described with reference to FIG. 12 and the like, and to perform the same operation.

(Third embodiment)
Next, a third embodiment of the invention will be described. The third embodiment of the present invention is an embodiment of a rotating portion 400 relating to a rotating mechanism of an opening/closing device, and the rest of the configuration is the same as that of the first or second embodiment. Descriptions of configurations that overlap with those of the first embodiment or the second embodiment will be omitted. FIG. 18 is a perspective view of the rotating part of the opening/closing device of the flexible surgical instrument changing device according to the third embodiment of the present invention. FIG. 19 is a perspective cross-sectional view showing the internal structure of the rotating part of the opening/closing device of the flexible surgical instrument exchange device according to the third embodiment of the present invention.

The opening/closing device 200 having a rotating surface needs to rotate the opening/closing rotating surface to match the organ gripping position when grasping an organ in a living body. The flexible operation member 122 coupled to the opening/closing device 200 is inserted into an oval cylindrical adapter 411 . The opening/closing device 200 rotates in cooperation with the cylindrical rotating cylinder 410 , and the adapter 411 having an oval cross section is inserted into the adapter fitting portion 450 so as to restrict rotation of the rotating cylinder 410 . . Further, the rotary cylinder 410 is rotatably inserted into the exterior 420 . With the rotating portion 400 having such a configuration, the rotating cylinder 410 is rotated within the exterior 420 to open and close on the rotating surface for opening and closing of the opening/closing device 200, i. Device 200 can be rotated.

Reference is now made to FIG. FIG. 19 shows a partial cross section (cross section along the XY axis in FIG. 18) of the surgical instrument operation section 50 side of the soft surgical instrument exchange device 1, which is the right depth side of FIG. A driven bevel gear 440 having radial teeth is formed around the cylindrical portion of the rotating barrel 410 . The driven bevel gear 440 may be integrated with or separate from the rotary cylinder 410 , but the rotation of the driven bevel gear 440 also causes the rotary cylinder 410 to rotate.

A drive bevel gear 430 is provided so as to mesh with the driven bevel gear 440 , rotating with a rotation axis perpendicular to the insertion/extraction direction into the living body. A driving bevel gear rotating shaft 431 serving as a rotating shaft of the driving bevel gear 430 is rotatably provided on the exterior 420 so as not to be affected by the rotation of the rotating cylinder 410 .

For example, a first wire 271 shown in FIG. 16 is wound around the driving bevel gear rotating shaft 431, and the first wire 271 is drawn in by moving the operating portion 216 in the axial direction, and the insertion/removal direction into and out of the living body. Rotate with orthogonal axes of rotation. The rotation of the drive bevel gear rotating shaft 431 causes the drive bevel gear 430 to rotate, and the rotation is transmitted to the driven bevel gear 440 .

According to this configuration, by rotating the drive bevel gear by pushing and pulling the wire, the driven bevel gear that meshes with the drive bevel gear can be rotated, and the opening/closing device, which is the treatment instrument, can be rotated. The rotating part 400 having such a configuration can rotate the opening/closing device to a position where the affected part is gripped. Note that the rotation mechanism shown in FIG. 19 is preferably arranged near the tip of the exterior 420 .

(Fourth embodiment)
Next, a fourth embodiment of the invention will be described. The fourth embodiment of the present invention is an embodiment relating to a mechanism for inserting a plurality of opening/closing devices into the living body and selecting a rotating device according to the operation, and other configurations are the same as those of the first to third embodiments. Therefore, in the following description, the description of the configurations overlapping with those of the first to third embodiments will be omitted. FIG. 20 is an explanatory diagram showing the operation of the rotating part of the opening/closing device of the flexible surgical instrument exchange device according to the fourth embodiment of the present invention.

Referring to FIG. 20(A), the rotating part and opening/closing device having the same configuration as in the third embodiment shown in FIG. 19 are arranged in parallel. First, looking at the right side of (A), the rotation exchange unit 500 includes a drive bevel gear 530 that rotates around a drive bevel gear rotation shaft 531 that is a rotation axis perpendicular to the insertion/extraction direction into and from the living body, A driven bevel gear 540 meshing with the drive bevel gear 530 is provided. As shown in FIG. 20(B), the rotation of the drive bevel gear 530 is transmitted to the driven bevel gear 540 to rotate the opening/closing device 200 and the flexible operation member 122 .

Looking again at FIG. 20A, the right side also has the same bevel gear transmission mechanism as the left side. Further, in (A), the driving bevel gears 530, 530 arranged on the left and right and the driven bevel gears 540, 550 on the left and right corresponding thereto are not meshed. Next, looking at (B), the transmission mechanism with the right bevel gear is moving in the direction of the arrow Z1. Movement can be accomplished by retracting the flexible manipulator 122 by means of storage drums 110, 280, or the like. By moving the transmission mechanism in the direction of arrow Z1 by the right bevel gear, the driven bevel gear 540 and the driving bevel gear 530 are meshed, and the opening/closing device 200 and the flexible operation member 122 can be rotated. Note that the rotation operation is the same as in the third embodiment. In (C), the same operation as in (B) is established by moving the transmission mechanism by the left bevel gear in the Z2 direction, and the opening/closing device 200 and the flexible operation member 122 are rotated. .

According to this configuration, even when a plurality of opening/closing devices are inserted into the living body, the drive bevel gear is rotated by pushing and pulling the wire, thereby rotating the driven bevel gear that meshes with the drive bevel gear. An opening/closing device, which is a treatment tool, can be rotated. Such a configuration can rotate the opening/closing device to a position where the affected part is gripped.

(Fifth embodiment)
Next, a fifth embodiment of the present invention will be described. The fifth embodiment of the present invention is an embodiment relating to a mechanism for inserting a plurality of opening/closing devices into a living body and selecting a rotating device according to the operation, and other configurations are the same as those of the first to fourth embodiments. Therefore, in the following description, the description of the configurations that overlap with those of the first to fourth embodiments will be omitted. FIG. 21 is a perspective view of the rotating part of the opening/closing device of the flexible surgical instrument changing device according to the fifth embodiment of the present invention.

Referring to FIG. 21, the fifth embodiment of the present invention includes a flexible shaft 600 for transmitting rotational power to a remote location within the outer tube 320 covering the first wire 271 and the second wire 272 of the second embodiment. is interpolated. The flexible shaft 600 is a flexible, elongated shaft component, and when one end is rotated, loss such as twisting can be reduced and the rotation can be transmitted to the other end.

In this embodiment, one end of the flexible shaft 600 can be protruded from the operation part 216 of FIG. 16 and the other end can be connected to the rotating barrel 410 . With this configuration, by rotating the flexible shaft 600 with the operating portion 216, the flexible operation member 122 and the opening/closing device 200 shown in FIG.

That is, according to this configuration, by inserting the first wire 271 and the second wire 272 into the flexible shaft 600, they can be arranged coaxially. By rotating only this flexible shaft 600, it is possible to rotate the opening/closing device 200, which is a surgical tool. It is preferable that the flexible shaft 600 extends as close to the axis as possible so that the rotation of the flexible shaft 600 reduces the resistance (friction and wear) when rotating the surgical instrument, which is the opening/closing device 200. becomes.

The rotating mechanism using bevel gears described in the third and fourth embodiments rotates the surgical instrument by pushing and pulling the operating wire, and the rotating mechanism using the flexible shaft of the present embodiment directly rotates the surgical instrument. can be appropriately selected depending on the storage space and bending conditions.

INDUSTRIAL APPLICABILITY As described above, the present invention is suitable for a flexible surgical instrument exchange device and its soft surgical instrument exchange device that facilitates exchange of surgical instruments and facilitates management of the sanitary conditions of the exchanged surgical instruments. It is possible to provide a flexible surgical tool.

REFERENCE SIGNS LIST 1 Flexible surgical tool exchange device 20 Storage unit 21 Storage box 22 Placement shelf 25 Opening 30 Replacement unit 33 Elevating transport unit 34 Roller 35 Belt 40 Delivery part 41 Delivery rod 42 Engagement part 45 Conveying surface 50 Operation part 51 Positioning tool 100 Operation unit 110, 280 Storage drum 111, 281 Operation unit storage unit 113 Flexible operation material storage groove 114 Biasing device 116, 216 Operation unit 117 Engagement hole 118 Detent key 119 Key groove 122 Flexible operation member 124 Actuating wire 125 Wire locking part 126, 320 Exterior tube 141 Third DESCRIPTION OF SYMBOLS 1 operation connection part 142... Rod 143... 2nd operation connection part 144... Engagement pin 150... Notch 160... Mounting protrusion 200,201,300... Opening/closing device 210 , 310... First rotating part 217... Wire guide part 218... Slit 219... Tensioner 220, 320... Second rotating part 221... Guide hole 230... Rotation center 231 Rotating shaft 240, 340 First pin 241 First center 242, 243, 342, 343 First groove 250, 350 Second pin 251 Third 2 center 252, 253, 352, 353 second groove 260 open/close guide 261, 262 guide groove 271 first wire 272 second wire 400 rotating part 410 Rotating tube 411 Adapter 420 Exterior 430, 530 Drive bevel gear 431, 531 Drive bevel gear rotating shaft 440, 540 Driven bevel gear 450 Adapter fitting Part 500 Rotation exchange part 600 Flexible shaft

Claims (7)

a soft surgical instrument that can be inserted into and removed from a living body and bendable in the living body;
a housing in which each of the plurality of soft surgical instruments according to the application is stored;
a storage unit that stores a plurality of the housings that are stacked in multiple stages in the vertical direction;
a replacement unit including an elevating mechanism that lowers or raises the storage unit so that the positions of the plurality of housings in the vertical direction sequentially coincide with the positions of the conveying surface;
a delivery unit that moves, in the direction of the living body, one of the plurality of housings whose vertical position coincides with the position of the transport surface;
a surgical instrument operation unit in which the moved housing is stored,
A soft surgical instrument exchange device, wherein the housing is exchangeable according to the application. The soft surgical instrument comprises a flexible cord-shaped insertion section having a distal end attached with a treatment instrument that opens and closes, and an operation section that operates the opening and closing movement of the treatment instrument,
the insertion portion includes a wire having one end connected to the treatment instrument and an exterior tube covering the wire;
The operation part includes a storage drum around which the insertion part is wound and rotated to insert/withdraw the insertion part, and the other end of the wire is fixed and rotates and winds in cooperation with the storage drum. Including an opening and closing mechanism that can move in a direction different from the direction,
The opening and closing mechanism opens and closes the treatment instrument by moving the storage drum in an axial direction that is different from the winding direction,
2. The housing according to claim 1, wherein the housing is provided with an operation connecting portion for rotating the housing drum and operating the movement of the housing drum in the axial direction from the outside of the housing. soft surgical instrument changer. The surgical instrument operation unit includes an operation mechanism connected to the operation connection unit,
3. The soft surgery according to claim 2, wherein rotation of the operating mechanism rotates the storage drum via the operating connecting portion, and pushing and pulling of the operating mechanism axially moves the open/close mechanism . equipment changer. The soft surgical instrument provided in the soft surgical instrument exchange device according to claim 2 or 3,
The outer tube houses a plurality of wires having one end connected to the treatment instrument,
A soft surgical instrument, wherein the other ends of the respective wires move independently in the axial direction of the storage drum. The treatment instrument includes a first rotating portion and a second rotating portion that have a common rotation shaft and are rotated in different directions to perform the opening and closing motion,
The first rotating portion and the second rotating portion are provided with an arc-shaped first groove having a first center eccentric to the rotating shaft on the opening operation side of the rotating surface; an arc-shaped second groove having an eccentric second center is formed on the closing operation side of the surface,
one wire is connected to the first groove of the first rotating portion and the first groove of the second rotating portion, and a first pin that is movable on the rotating surface is inserted;
Another wire is connected to the second groove of the first rotating portion and the second groove of the second rotating portion, and a second pin that is movable on the rotating surface is inserted. The soft surgical instrument according to claim 4, characterized in that: The insertion portion
a cylindrical exterior;
a rotating part that is rotatably inserted into the exterior part and fitted on the treatment instrument so as to restrict the rotation of the treatment instrument;
a driving bevel gear that rotates about a rotation axis in a direction perpendicular to a direction of inserting and withdrawing the wire into and out of the living body by moving the wire in the axial direction of the storage drum;
6. The soft surgical tool according to claim 4, further comprising a driven bevel gear provided on the rotating portion and meshing with the drive bevel gear. A flexible shaft having one end connected to the treatment instrument is housed in the exterior tube,
5. The soft surgical instrument according to claim 4, wherein the treatment instrument is rotated by rotating the other end of the flexible shaft.

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